Quebec's new assisted-dying law leaves doctors struggling to adapt

Two months after Quebec’s assisted-dying law came into effect, about 10 patients have chosen to end their lives with the help of a doctor. But some doctors remain reluctant and still fear legal reprisals.

Fear of legal reprisal still widespread among health professionals

A close-up of two people holding hands - one person being a patient in a hospital bed.
Even though most doctors in Quebec approve of medically assisted dying, many do not want to perform the procedure themselves. (Chris Kreussling)

Two months after Quebec's assisted-dying law came into effect, about 10 patients have chosen to end their lives with the help of a doctor.

Health Minister Gaétan Barrette says this is a sign that things are going well and there are no systematic obstacles.

"The information that I have from the ground and from the College of Physicians is that teams are in place and that access is there," Barrette said.

"Problems, if there were any, were resolved quickly."

Doctors and patient advocates tell a different story.

Jean-Pierre Ménard, a lawyer specializing in health law, says his clients have reported trouble obtaining medical assistance to die.

Agreeing with an idea does not mean that one is prepared to perform the procedure.– Christiane Martel, Quebec Society for Palliative Care

Under the new law, two doctors must assess a patient's request for medically assisted suicide, but finding the physicians is sometimes a challenge.

"In one case, we ended up finding them, but very late. When it came the time to assess the case, the patient's condition had deteriorated substantially and we could not proceed," Ménard said.

This, he said, is due to the reluctance of health workers to be involved in an end-of-life decision. Before the law was passed, court cases against doctors had multiplied.

"But now it's very clear. A doctor who medically assists a death no longer risks criminal or civil prosecution," he said.

Doctors often reluctant

Louis Roy, a palliative care physician in Quebec City, also said that getting medical help to die can be complicated.

"As there seems to be few doctors willing to accept a request, it can be quite long in terms of days," Roy said.

Quebec Health Minister Gaétan Barrette says the new law means a period of adjustment for doctors. (Jacques Boissinot/Canadian Press)
This reluctance among doctors shows a split between a general acceptance of medically assisted dying and the willingness to perform it, said Christiane Martel, president of the Quebec Society for Palliative Care.

"Doctors said they agreed with the idea when they took surveys. But to agree with an idea does not mean that one is prepared to perform the procedure," Martel said.

Martel thinks that the proportion of doctors willing  to work on medically assisted death is very low.

"In our region, it's less than one per cent of doctors," she said.

A taboo procedure?

Several doctors approached by Radio-Canada expressed discomfort with performing medically assisted death.

They said they don't want to be singled out as doctors who help others die. Those willing to evaluate a case want it to be done discreetly.

"They do not want to be labelled as a medical resource that will assess all cases in a region," Martel said.

The complexity of the process also requires a significant time commitment. Louis Roy estimates this might require five to eight hours of monitoring over several days.

"In medicine, people work a lot. If we accept this long and quite difficult task, it's added on top of everything else."

Patients may not qualify

Another complication is the numerous requests made by patients who do not qualify for the procedure.

Roy believes that patient expectations can be unrealistic.

"We have to start from scratch, pull out the elements of the law and ask, 'Do you think your health condition meets the criteria?'" he said.

Roy said information on medically assisted dying must be improved. Quebec should also launch a national information campaign, he said.

Barrette believes the situation will gradually improve.

"We are at the beginning of the application of the law, and given the small number of cases that have occurred, it's understandable that teams are still figuring things out," he said.